Cost-Effectiveness Analysis of Prophylaxis Treatment Strategies to Reduce the Incidence of Febrile Neutropenia in Patients with Early-Stage Breast Cancer or Non-Hodgkin Lymphoma

Kelly Fust (), Xiaoyan Li, Michael Maschio, Guillermo Villa, Anju Parthan, Richard Barron, Milton C. Weinstein, Luc Somers, Caroline Hoefkens and Gary H. Lyman
Additional contact information
Kelly Fust: Optum
Xiaoyan Li: Amgen Inc.
Michael Maschio: Optum
Guillermo Villa: Amgen (Europe) GmbH
Anju Parthan: Optum
Richard Barron: Amgen Inc.
Milton C. Weinstein: Harvard T.H. Chan School of Public Health
Luc Somers: OncoLogX bvba
Caroline Hoefkens: Amgen Belgium S.A.
Gary H. Lyman: Fred Hutchinson Cancer Research Center

PharmacoEconomics, 2017, vol. 35, issue 4, No 3, 425-438

Abstract: Abstract Objective The objective of this study was to evaluate the cost effectiveness of no prophylaxis, primary prophylaxis (PP), or secondary prophylaxis (SP) with granulocyte colony-stimulating factors (G-CSFs), i.e., pegfilgrastim, lipegfilgrastim, filgrastim (6- and 11-day), or lenograstim (6- and 11-day), to reduce the incidence of febrile neutropenia (FN) in patients with stage II breast cancer receiving TC (docetaxel, cyclophosphamide) and in patients with non-Hodgkin lymphoma (NHL) receiving R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone) over a lifetime horizon from a Belgian payer perspective. Methods A Markov cycle tree tracked FN events during chemotherapy (3-week cycles) and long-term survival (1-year cycles). Model inputs, including the efficacy of each strategy, risk of reduced relative dose intensity (RDI), and the impact of RDI on mortality, utilities, and costs (in €; 2014 values) were estimated from public sources and the published literature. Incremental cost-effectiveness ratios (ICERs) were assessed for each strategy for costs per FN event avoided, life-year (LY) saved, and quality-adjusted LY (QALY) saved. LYs and QALYs saved were discounted at 1.5% annually. Deterministic and probabilistic sensitivity analyses (DSAs and PSAs) were conducted. Results Base-case ICERs for PP with pegfilgrastim relative to SP with pegfilgrastim were €15,500 per QALY and €14,800 per LY saved for stage II breast cancer and €7800 per QALY and €6900 per LY saved for NHL; other comparators were either more expensive and less effective than PP or SP with pegfilgrastim or had lower costs but higher ICERs (relative to SP with pegfilgrastim) than PP with pegfilgrastim. Results of the DSA for breast cancer and NHL comparing PP and SP with pegfilgrastim indicate that the model results were most sensitive to the cycle 1 risk of FN, the proportion of FN events requiring hospitalization, the relative risk of FN in cycles ≥2 versus cycle 1, no history of FN, and the mortality hazard ratio for RDI (

Keywords: Breast Cancer; Febrile Neutropenia; Filgrastim; Pegfilgrastim; Primary Prophylaxis (search for similar items in EconPapers)
Date: 2017
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DOI: 10.1007/s40273-016-0474-0

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